Traumatic laceration of the portal vein

Abstract

Despite its relatively protected position, the liver is the most frequently injured solid intra-abdominal organ. 1 Most liver injuries can be managed conservatively, but about 5% to 10% require urgent laparotomy, usually when the mechanism of injury involves a vehicle accident and hemodynamic instability persists, in spite of 40 mL/kg of blood transfusion. 2,3 In particular, grades IV and V liver injuries may pose a challenge to the surgeon trying to control hemorrhage, the leading cause of mortality. 4 Traumatic injuries to the portal vein are rare but devastating. The mortality rate for portal vein injury ranges from 50% to 70%. A recent study of portal triad injuries has highighted the higher mortality rates associated with combination injuries involving multiple portal triad components, especially those that include portal vein injury. 5 This case study describes a unique case of relatively minor trauma in a child resulting in portal triad injury, sudden demise, and surgical repair. RÉSUMÉMalgré sa position relativement bien protégée, le foie est l'organe solide, intra-abdominal le plus souvent lésé (1). Dans la plupart des cas de lésion traumatique du foie, un traitement conservateur suffit, mais, dans environ 5 à 10 % des cas, il faut procéder à une laparotomie d'urgence, généralement lorsque ces lésions résultent d'un accident de véhicule et qu'elles entraî-nent une instabilité hémodynamique persistante, malgré des transfusions de sang à raison de 40 ml/kg (2,3). Les lésions hépatiques du 4 e ou 5 e degré en particulier peuvent compliquer la tâche du chirurgien, qui tente de réprimer l'hémorragie, cause principale de mortalité (4).Les lésions traumatiques de la veine porte sont rares, mais elles peuvent être mortelles. Le taux de mortalité lié aux lésions de la veine porte varie de 50 à 70 %. D'après une étude récente sur les lésions des espaces portes, les taux de mortalité les plus élevés sont associés à la concomitance de blessures touchant plusieurs constituants des espaces portes, notamment la veine porte (5). Sera exposé ici le cas plutôt exceptionnel d'un enfant ayant subi un trauma relativement peu important, qui a causé une lésion des espaces portes, s'est soldé par un effondrement soudain et a nécessité une réparation chirurgicale. CASE REPORTA 9-year-old boy was admitted to our hospital with abdominal pain after falling from his bike. His medical history revealed that he fell from his bike facedown 15 minutes before admission. His Glasgow Coma Scale (GCS) was normal at 15. Abdominal examination revealed tenderness on all abdominal quadrants by palpation. Initial vital signs were normal; however, focused assessment with sonography for trauma (FAST) showed common free fluid in the abdomen mainly on perihepatic, Morrison's pouch. His general condition was stable, so abdominal computed tomography (CT) was ordered. The CT scan showed a grade IV liver laceration on the falciform ligament enhancing left portal vein 6 cm in diameter, leading to free fluid

Contrecoup Injury associated with Fatal Portal Vein Bleeding: A Case Report

“…The liver is the most frequently injured solid organ in the abdominal cavity in patients with blunt body trauma and sometimes severe liver injury creates uncontrollable internal bleeding which can be the cause of mortality ( 5 ). However, because of the liver's complicated internal structures, a concomitant liver injury in patients with blunt abdominal trauma is sometimes hard to evaluate.…”

“…Although portal vein injuries rarely occur in traumatic events, the mortality associated with portal vein rupture is very high in the 50–70% range ( 7 ). Initial detection and isolation of a portal vein injury is difficult, and adjacent organs can also be severely damaged, that causes the high mortality rate ( 5 ). Buckman et al ( 8 ) emphasized the difficulty of the preoperative diagnosis of a portal vein injury.…”

Teratoma arising from hepato duodenal ligament in the newborn with transection of portal vein, hepatic artery and common bile duct: A surgical challenge

“…[ 2 ] Twenty-seven children with giant liver tumors involving the hepatic hilum have been described with one teratoma and the rest being malignant tumors. [ 3 ] However, these are primarily liver tumors extending on to hilum of liver. In this child, histologically, the liver parenchyma was not seen in the tumor.…”

“…A recent study of injuries to portal vein and hepatic artery has highlighted the higher mortality rates associated with combination injuries involving multiple components, especially those that include portal vein injury. [ 3 ] In another study, 66% of deaths occurred in the operating room, primarily from exsanguinations; 18% of deaths occurred within 48 h of injury from refractory shock, coagulopathy, or cardiac arrest. [ 4 ] The child needed a massive transfusion of nearly 350 ml of blood.…”